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Catholic Medical Quarterly Volume 61(3) August 2011,  38

Can drug abusers make good mothers? 70% success in Malta!

From the Anscombe centre meetings in Westminster.

Picture of Dr Anna VellaDr Anna Maria Vella came to talk to the Anscombe Ethics Forum in Westminster in March. She works in Malta with pregnant women who abuse heroin.

There has been a dramatic increase in addictions in the past decades. She posed several questions including "Do they need special care? Will they benefit from mixing with other mothers? Might other mothers be harmed by such mixing?"

In Malta and the UK unborn children do not have legal rights and yet a central focus of care will be the well being of the born child.

Dr Vella discussed the dilemma that autonomy is centred around informed choice: women may not be autonomous if they do not have a clear understanding of the risks. Once doctors have informed them of the risks, women may make their own choice. In substance abusing mothers we may feel that the mother may lack some autonomy and therefore that  imposition of care is more justified. Allowing autonomy in such circumstances may be very painful for doctors.

We must remember that women do not abuse drugs out of a lack of care for their children. Addiction is an obsessive compulsive disorder which is a complete, chronic and relapsing bio-psycho-social disease. Psycho-active substances are used for pleasure or relief of pain and users believe they will be in control before it is too late.

Of course the early things to explore in drug abusing mothers include a full assessment of debts, how money is earned (including prostitution) and court cases etc. Engendering hope is central. In Malta, the extended family is often used for fostering and this is positive. Many studies show that children are almost always better off with their parents. Therefore, we have a real duty to enable women to become better mothers. We must enable skills, competence and ability. Doing that requires a considerable amount of work to engage women in treatment. It may well mean supporting a woman during pregnancy while she continues to abuse drugs.

These are complex issues and the desire to support a healthy baby as well as the well-being and autonomy of the mother may not always be easy to reconcile. But pragmatically, working with a challenging mother is much better than imposition. Sadly, drug abusing mothers do not usually get to keep their babies. If it can be done, benefits for mother and baby may be huge. Dr Vella thinks that about 70% of women can be supported to parent their children, but this is with the support of the extended family.